PROJECT SUMMARY/ABSTRACT This K08 Mentored Career Development Award's overall objective is to support Dr. Kathleen A. McManus at the outset of her career, providing sufficient time to focus her research on critical issues in the intersection of epidemiology, HIV health outcomes, and health policy. Her Career Development Plan will use the context of her research for three goals: 1) master skills (design, analysis, and interpretation) of quantitative epidemiologic research; 2) gain expertise in the application of these analyses to state and federal health policy; and 3) independence. Her overarching K08 research goal is to deconstruct HIV viral suppression disparities. Specifically, she will perform secondary analyses of multistate (Virginia and South Carolina) data to 1) identify demographic and healthcare system-level factors associated with loss to follow-up of AIDS Drug Assistance Program (ADAP) clients; 2) estimate the effect of Affordable Care Act (ACA) Qualified Health Plan status on sustained individual HIV viral suppression and assess disparities in outcomes among ADAP clients; and 3) quantify the state/population level effect of modifiable healthcare delivery factors as mediators that impact disparities in viral suppression by race/ethnicity among ADAP clients. HIV viral suppression is a key outcome. It benefits individuals' longevity as well as the community since it is associated with decreases in new cases of HIV infection. This research will inform policies to reduce disparities for low-income PLWH served by ADAP. In order to monitor progress toward achieving HIV goals, states need accurate, timely data. If loss to follow-up results in data that is not missing completely at random, this could result in biased data and suboptimal policies. Understanding factors affecting loss to follow-up will help ADAPs to identify priority groups for interventions and will allow for adjustment of future analyses for selection bias. Studying this multistate ADAP cohort's ACA experience is applicable to ~225,000 ADAP clients across the nation. If the ACA is changed or repealed, or if Virginia or South Carolina expand Medicaid, the project will be adjusted to study the impact of those changes. This proposal will provide important information for state and federal policy and could become a model for HIV analyses in other states and at the federal level. It fulfills main components of the United States' National HIV/AIDS Strategy by identifying strategies to strengthen the timely availability and use of high quality data and by characterizing modifiable factors' effects on disparities that can be targeted for interventions. This proposal benefits from a strong advisory team of leading researchers with expertise in epidemiology, casual inference, econometrics, health outcomes, health policy, and HIV outcomes. Drawing from the mentorship, collaboration, and support of the Divisions of Infectious Diseases and Public Health Sciences, and state partners in Virginia and South Carolina, the University of Virginia is an ideal institution for this award with the long-term goal that Dr. McManus will become an independent clinician-researcher focused on improving health outcomes for people living with HIV by optimizing data collection and analysis, and translation of data into policy and action.